BACKGROUND: In recent years, there has been increasing interest in studying differences in recipient sex in renal disease treatment, access to renal replacement therapy, and subsequent outcomes. Our aim was to find out whether there are differences in outcomes after renal transplantation between female and male kidney transplant recipients in our series, particularly in adults under 60 years of age during long-term follow-up. METHODS: This was a retrospective study of our kidney transplant series ( = 1,101) to compare graft survival depending on the sex of the recipient in the entire series and patients < 60 years of age ( = 687) during long-term follow-up. RESULTS: We observed no association between recipient sex and graft survival throughout the series, regardless of recipient sex. However, adult female recipients under 60 years of age had lower graft survival than male recipients ( = 0.040). Pre-transplant sensitization (HR 2.438, = 0.002) and donor age (HR: 1.021, = 0.017) were the independent variables associated with graft failure. CONCLUSION: Female recipients younger than 60 years of age had lower graft survival than male recipients, although there were no gender differences in graft or patient survival in the overall study population. Recipient sex was not related to graft failure, but the greater immunological risk in women and more frequent use of expanded criteria donors in female recipients under 60 years of age were the main factors related to their poorer graft survival. Further studies and new strategies are needed to identify these differences and develop the best approach to address them.